ACCESS TO A NUTRITIOUS FOOD BASKET IN EEYOU ISTCHEE

Transcription

1 ACCESS TO A NUTRITIOUS FOOD BASKET IN EEYOU ISTCHEE Project Report Marie-Paule Duquette, P.Dt. Candice Scatliff, M.Sc. Janine Desrosiers Choquette A project conducted thanks to a grant from the Public Health Department of the Cree Board of Health and Social Services of James Bay March 2013

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3 TABLE OF CONTENT Page List of tables List of figures List of appendices Acknowledgements Summary ii iii iv v vi Introduction 1 Project Description 4 Methodology 6 Results 13 Eeyou Istchee 13 Jamésie 22 Comparing Eeyou Istchee and Jamésie 25 Eeyouch Purchasing the NFB in Jamésie 26 Effect of the Deprivation Index 28 Stores of Abitibi Urban Centres 29 Discussion 30 Eeyou Istchee 30 Comparison of the Cost of the NFB in Eeyou Istchee and Other Areas 35 Conclusion 38 References 39 Appendices i

4 LIST OF TABLES Table 1. Composition of the food categories in the NFB 8 Table 2. Table 3. Table 4. Weekly food category allowances for each group of age (years), sex and physiological condition Description of the sites of the 16 Eeyou Istchee stores in which price tallying was conducted according to store size, urbanization level and deprivation index Distribution of the 16 Eeyou Istchee stores according to store size per community and the deprivation index of the community Table 5. NFB items truly missing per Eeyou Istchee individual community 14 Table 6. Number of Eeyou Istchee communities in which NFB items were totally unavailable* Table 7. Average cost of the NFB categories in Eeyou Istchee 15 Table 8. Table 9. Weekly cost of the NFB per group of age, sex and physiological condition in Eeyou Istchee Weekly cost of the NFB for the reference family of four in Eeyou Istchee and its individual communities Table 10. Description of the sites of the 5 Jamésie stores in which price tallying was conducted Table 11. Average cost of the NFB categories in Jamésie 23 Table 12. Weekly cost of the NFB per group of age, sex and physiological condition in Jamésie Page ii

5 LIST OF FIGURES Page Figure 1. Classification of urbanization levels: ZONES and ZMI 10 Figure 2. Regression of number of NFB items missing in Eeyou Istchee stores by the inverse of store size Figure 3. Number of missing food items by store size in Eeyou Istchee 18 Figure 4. Cost of the NFB in coastal and inland Eeyou Istchee communities 19 Figure 5. Figure 6. Figure 7. Figure 8. Figure 9. Eeyou Istchee Proportion of the after-tax median income occupied by the cost of the NFB for four types of families with two children Eeyou Istchee Proportion of the after-tax median income occupied by the cost of the NFB for four types of families with three or more children Jamésie Proportion of the after-tax median income occupied by the cost of the NFB for four types of families with two children Cost of the NFB for the reference family in Jamésie compared to Eeyou Istchee Cost of the NFB in Jamésie compared to coastal and inland Eeyou Istchee communities Figure 12. Cost of the NFB by material deprivation quartile Figure 10. Figure 11. Eeyouch purchasing food in Jamésie Proportion of the after-tax median income occupied by the cost of the NFB for four types of families with two children Eeyouch purchasing food in Jamésie Proportion of the after-tax median income occupied by the cost of the NFB for four types of families with three or more children iii

6 LIST OF APPENDICES Appendix 1. Appendix 2. Appendix 3. Appendix 4. Appendix 5. Appendix 6. Appendix 7. Letter to the store managers and Consent Form Accès à un panier à provisions nutritif dans la région d Eeyou Istchee Cahier de formation Price Tallying Form (in French) Modification pour le relevé de prix Baie-James-Nord-du-Québec Availability and non-availability of the NFB Food and Use of Substitutes in 16 stores of Eeyou Istchee Cost of the Nutritious Food Basket in the Eeyou Istchee Coastal communities, including the price of individual food items Cost of the Nutritious Food Basket in the Eeyou Istchee Inland communities, including the price of individual food items iv

7 ACKNOWLEDGEMENTS The authors wish to thank the following: Mr. Paul Linton, Assistant Director of Public Health (Chishaayiyuu Miyupimaatisun) for supporting this project and providing funding through the Aboriginal Diabetes Initiative (Health Canada); Ms. Chantal Vinet-Lanouette, P.Dt., Ms. Catherine Godin, P.Dt., and Ms. Lilian Kandiliotis, P.Dt., Nutritionists, Public Health Department, Cree Board of Health and Social Services of James Bay, for initiating the ACCESS TO A NUTRITIOUS FOOD BASKET IN EEYOU ISTCHEE as well as their contribution in price tallying and informative support throughout the realization of the project; Mrs. Marie-Claude Guertin, statistician at the Centre de coordination de l Institut de cardiologie de Montréal, who provided support with the statistical tests as well as the analysis and interpretation of the results; Mrs. Jackie Demers, P.Dt., dietitian at the Montreal Diet Dispensary, who prepared and delivered the training session on price tallying for the Nutritious Food Basket as well as elaborated the document "Modifications pour le relevé de prix Baie James-Nord-du-Québec"; Ms. Yi-Hsuan Chiang, P.Dt., dietitian at the Montreal Diet Dispensary, for data entry and verification. v

8 ACCESS TO A NUTRITIOUS FOOD BASKET IN EEYOU ISTCHEE SUMMARY Food insecurity occurs when people cannot or are uncertain of being able to acquire quality foods in a socially acceptable manner and in sufficient quantity. It is associated with various health impairments and may be caused by insufficient income as well as lack of availability of quality food. The Montreal Diet Dispensary (MDD) publishes a Nutritious Food Basket (NFB) three times a year since the early 1950's. In the last decade, various Quebec public health organizations, as part of their food security program, have commissioned the MDD to conduct studies on the cost and accessibility of the NFB in their respective regions. As food insecurity is present in approximately one out of four Eeyouch, the ACCESS TO A NUTRITIOUS FOOD BASKET IN EEYOU ISTCHEE project was planned in the context of health promotion and prevention of chronic diseases. Objectives The project aimed to establish the cost and availability of the NFB items in the stores of Eeyou Istchee and nearby urban centres in which the Eeyouch regularly purchase food. Secondary objectives of the project were the following: establish the availability of the NFB items in the region; determine the cost per NFB category; determine the variation of the average minimal cost of the NFB according to store size and the urbanization and deprivation levels of their site; verify the expiration date of some of the NFB items. In collaboration with the nutritionists working in Eeyou Istchee, the MDD adapted the content of the NFB with suitable substitutes as unavailability of some of the items was expected. A training session on price tallying was held. The MDD also planned data treatment and analysis for the project, including economical data. The nutritionists contacted the stores managers to obtain their participation in the project and were responsible for price tallying. Price tallying was held in 16 stores of Eeyou Istchee, 5 of Jamésie and 3 of Abitibi, in September 2011, during the week of the 26 to the 30. From the data collected, the following results were obtained Refers to residents of Eeyou Istchee, James Bay Cree Territory, Quebec. vi

9 In the Stores of Eeyou Istchee Availability of the NFB Items Out of the 71 NFB items, the number that were truly missing per community ranged in more or less a similar pattern in the inland and coastal communities: between 2 and 14 items missing. On the other hand, when percentages of items missing were considered, it was twice as high in inland communities compared to coastal ones (31.2% vs 16.8%). Expiration date was surveyed for milk, eggs, cheese and bread; none of these items were expired. Cost of the NFB Categories The general trend was higher costs in coastal compared to inland communities. Cost of the NFB per Group of Age, Sex and Physiological Condition Weekly allowances for individuals are based on nutritional needs per age and sex and the cost of the NFB varies accordingly. Pregnancy and lactation are physiological conditions in which the nutritional needs of women increase; accordingly, the cost of the NFB increases by $7 to $10. And, comparing the cost of the additional needs for lactation to the price of infant formula established that breastfeeding represents a saving of at least $30 per week. Cost of the NFB The average weekly cost of the NFB for the MDD reference family of 4 (a man and a woman 31 to 50 years old, a boy 14 to 18, and a girl 9 to 13) was $ The cost was higher in the coastal communities ($338.71) than in the inland ones ($268.73). The average cost of the NFB for a larger family, more representative of Eeyouch families (a child 1 to 3 years old and a boy 4 to 8 in addition to the MDD reference family), was $ Results According to the Independent Variables Among the independent variables (store size, urbanization level, and deprivation index), only store size was shown to be related to the availability of the NFB items: the smallest stores had more items missing, compared to stores of larger size. None of the independent variables influenced the cost of the NFB or the differences noted between the stores in the inland and coastal communities. Cost of the NFB in the Economical Context of Families To calculate the portion of the family budget required to purchase the NFB, the after-tax median family income was used. The calculations were conducted for families with two children (MDD reference family) as well as for families with three or more children as the latter are more representative of Eeyouch families. The results showed that, for average-income families comprising a couple, the proportion of family income required to purchase the NFB in Eeyou Istchee was 21% for families with two children, and 29% for families with three or more children. In comparison, it was: twice as high for average-income single-parent family; 2½ to 4 times as high for low-income families. Thus, food security is jeopardized for these families. Data excluding Oujé-Bougoumou where there was only a convenience store (41 NFB items missing). The NFB item was not available in any of the stores in a community. vii

10 In the Stores of Jamésie and of Abitibi Urban Centres Very few of the NFB items were missing in these stores. The cost of the NFB ranged from $ per week in one Abitibi store to an average of $ per week in Jamésie. Comparing Eeyou Istchee and Jamésie Cost of the NFB The cost of the NFB was shown to be significantly higher ($86.26 per week) in Eeyou Istchee compared to Jamésie. When this comparison differentiated coastal and inland communities in Eeyou Istchee, only coastal stores remained statistically more expensive compared to Jamésie, with a difference of $ per week. Cost of the NFB in the Economical Context of Families Eeyou Istchee residents frequently purchase food in Jamésie where the NFB is less expensive. Thus, a lower percent-of-income is needed to purchase the NFB in the stores in Jamésie. However the cost of transportation must be weighed against the potential savings (approximately $110 per week for families in the coastal communities and $40 per week for families in inland communities) to confirm that there is an overall cost savings to this practice. Effect of the Deprivation Index With the 21 stores combined, material deprivation was shown to significantly affect the cost of the NFB: it is higher ($ per week) in stores situated in areas with strong material deprivation compared to those with weak material deprivation. Comparing the Cost of the NFB in Eeyou Istchee to Other Areas The cost of the NFB in Eeyou Istchee is higher than any other studied Quebec regions. Conclusion In Eeyou Istchee, eating well is of concern for the average-income singleparent family while it appears to be out of reach for low-income families. The food delivery system in Eeyou Istchee does not maximize healthy choices and community self-reliance. The cost of food is very high while choices are limited. Long-term strategies towards ensuring food security are needed to prevent chronic diseases and promote health. viii

11 ACCESS TO A NUTRITIOUS FOOD BASKET IN EEYOU ISTCHEE INTRODUCTION The ACCESS TO A NUTRITIOUS FOOD BASKET IN EEYOU ISTCHEE project was planned in the context of health promotion and prevention of food insecurity for the population of Eeyou Istchee. FOOD SECURITY, A DETERMINANT OF HEALTH Sound nutrition is known to be part of a healthy lifestyle, but low income may cause food insecurity, defined as the inability to acquire sufficient quantity of quality foods, in a socially acceptable manner, or the uncertainty of being able to do so 1. People affected by food insecurity are at risk of having a poor, or just fair, health status. Insufficient or poor quality dietary intake caused by food insecurity contributes to health problems in mothers and their offspring 2,3 and may aggravate the situation of people already at risk of developing diabetes 1. Studies have also indicated an association between food insecurity and the incidence of obesity in preschool children 4,5 Food insecure people are prone to chronic diseases, such as heart conditions, diabetes, obesity, hypertension, and food allergies 6. Food insecurity is more common among diabetics than among non-diabetics 7. Food insecurity may also jeopardize the control of chronic diseases that require modifications of food habits: studies have indicated that adult diabetics in households affected by food insecurity needed medical attention more often than diabetic people from other households 1. Psychological, social and physical consequences are also associated with food insecurity: examples of such consequences are social exclusion and mental health problems such as anxiety and depression in children and adults 6. Improving food security is therefore a primary prevention strategy to prevent chronic illnesses. Health CONTEXT OF THE EEYOU ISTCHEE REGION In Eeyou Istchee, 17% of people 12 years and over deem themselves to be in fair or poor health. That proportion is significantly greater among people in the 65 and over (28%) and age groups (24%), compared to the (15%) and (10%) age groups. A greater number of Eeyou Istchee residents deem themselves to be in fair or poor health compared to the rest of Quebec (17% vs. 11% respectively) 8. As of the end of 2011, one in five Cree aged 20 years or over had diabetes (22%) which is almost four times the rate of the Quebec population 9. 1

12 Food Insecurity In 2003, slightly more than one quarter (27%) of the adult population of Eeyou Istchee experienced food insecurity in the year preceding the survey, compared to nearly 15% of other Quebec residents 10. Food insecurity is less frequent among residents who have completed postsecondary studies (14%) compared to residents of lower educational level (32%). Food insecurity is more prevalent in households of six people or more (31%) than in households of three people or less (19%) 10. Between 1998 and 2000, one-fifth (20.8%) of mothers (of nine-month old babies) were anxious about the food supply 11. In 2010, 14% of parents reported that their young child sometimes went hungry when the family was out of money for food. For about one out of four children who went hungry (i.e. 3-4 % of all children under six), this happened at least once a month 12. Family Composition Households in the region are larger than elsewhere in Quebec: 74% have four or more residents. More than a third (37%) of households in Eeyou Istchee are composed of six or more people. Furthermore, 71.8% of households are composed of a couple with children and 12.9% are single-parent families 13. Employment and Income In 2003, 41% of the labour force was employed year round, and another 35% employed for part of the year. As for unemployment, there are noticeable variations by sub-region, the rate being significantly higher in the coastal communities than the inland ones (28% vs. 17%). People with some postsecondary education were more likely than those with a high school degree or less to be employed throughout the year (55% vs. 29%) 13. Data on the rates of low-income families are only available for the entire Nord-du- Québec region (comprising Eeyou Istchee, Jamésie and Kativik ). Between 2005 and 2006 the Nord-du-Québec was the only region in Quebec in which the rate of lowincome increased; the rate among the entire population was 18.1% and among families, 16.5% in In 2009, the rate of low-income was as follows: 5.6% in families comprising a couple with two children; 10.0% in families comprising a couple with three or more children; 40.5% in single-parent families with two children; 40.7% in single-parent families with three or more children 15. Cost of Food In 1996, as part of a study conducted by Indian and Northern Affairs Canada, the weekly cost of the Northern food basket for a family of four was substantially higher in Waskaganish ($214) than in Ottawa ($125) and Kuujjuaq ($180) 16,17. Whenever accessibility to healthy store-bought foods is discussed in Eeyou Istchee, the high cost and the lack of availability of these foods are often mentioned. Since the Both Kativik and Nunavik occupy the territory above the 55 th parallel of Quebec. Nunavik includes the Cree Whapmagoostui community while Kativik does not. Including people not living within a family. 2

13 situation seems to greatly affect the food choices of the population, this project aims to assess the current situation of both food cost and availability in the region. THE NUTRITIOUS FOOD BASKET OF THE MONTREAL DIET DISPENSARY Since the early 1950 s, the Montreal Diet Dispensary (MDD) publishes a Nutritious Food Basket (NFB). The basket satisfies, at minimal cost, the nutritional needs of individuals according to age, sex and physiological condition (pregnancy and lactation). Three times per year, pricing of the foods in the basket is undertaken in Verdun, representing disadvantaged neighbourhoods of Montreal 18. In addition to its use in nutrition counselling, the NFB provides a tool in support of the population at risk of food insecurity. The selection of the foods in the NFB of the MDD is based on the following criteria: the nutritive value and low cost, with consideration of consumer trends. For calculating the nutritive value of the food categories in the NFB, the MDD uses the food composition table published by the Université de Montréal 19. When no data is available in this table, other sources are consulted 20,21,22. Calculation of the food basket considers the energy (kcal) and composition of protein, carbohydrate, total fat, saturated fatty acids, trans fatty acids, cholesterol, polyunsaturated fatty acids (omega-6: linoleic, and omega-3: α-linoleic, eicosapentaenoïc, docosahexaeoic), minerals (calcium, phosphorus, iron, sodium, potassium, magnesium, zinc), vitamins (A, B1, B2, niacin or B3, folic acid, pantothenic acid, B6, B12, C, D, E) and total fibre of food items. In 2005, while developing an action plan for food security for the Island of Montreal, the Direction de santé publique (DSP) commissioned the MDD to conduct a study to determine if the NFB was accessible to all Montrealers, with particular interest given to economically disadvantaged people 23. Having established the average cost of the NFB at $5.50 per person per day, the project showed that the cost of the NFB was 32% of the cost of the MDD Minimum Adequate Standard of Living 24, while in reality low-income households (less than $22,000 per year) in Quebec spent only 21% of their income on food. The results of the Montreal study prompted the Quebec Ministère de la Santé et des Services sociaux (MSSS) to commission the MDD in 2009 to undertake a study on the cost of the NFB in three regions of Québec. The report of this study conducted in 140 stores was published in October Results indicate that in the Capitale- Nationale and Mauricie/Centre-du-Québec regions the cost of the NFB is similar to Montreal, but higher in the Côte-Nord region. THE ACCESS TO A NUTRITIOUS FOOD BASKET IN EEYOU ISTCHEE PROJECT The project on ACCESS TO A NUTRITIOUS FOOD BASKET IN EEYOU ISTCHEE aimed to establish the cost and availability of the NFB items in the stores of Eeyou Istchee and nearby urban centres in which Eeyouch regularly purchase food. Refers to residents of Eeyou Istchee, James Bay Cree Territory, Quebec. 3

14 ACCESS TO A NUTRITIOUS FOOD BASKET IN EEYOU ISTCHEE PROJECT DESCRIPTION The first objective of the project was to: determine the average minimal cost of the NFB in the stores of Eeyou Istchee as well as in nearby urban centers in which the Eeyouch regularly purchase food. The secondary objectives were to: determine the variation of the average minimal cost of the NFB according to store size and the urbanization and deprivation levels of their site; determine the cost per NFB category; establish the availability of the NFB items in the region; verify the expiration date of certain perishable food items of the NFB. COMPONENTS OF THE PROJECT The project was conducted by tallying prices of the NFB items in the food stores in Eeyou Istchee as well as nearby urban centres where the population regularly purchases food. The project was divided into three main components: planning; data collection; results. Planning Stores A total of eighteen (18) food stores were identified in the Eeyou Istchee region (11 in the coastal area and 7 inland), six (6) in Jamésie and ten (10) in Abitibi urban centres. The Cree Board of Health and Social Services of James Bay (CBHSSSJB) nutritionists sent a letter to the managers of these stores and requested a written confirmation of their participation in the project (Appendix 1). Description of the Region A preliminary study of the region was necessary for the analysis of urbanization 26 and deprivation levels 27,28,29,30. In addition, data on the income situation of the Eeyou Istchee population was necessary to analyse the results in the context of household budgeting. Analysis In the project, planned independent variables were store size, urbanization level and deprivation index. An analysis expert and a statistician were available, on contract to process the results. Standardization of the Materials The data collection tools and training material previously used in other studies were revised in order to hold a one-day training session instead of a two-day one. These were the Cahier de formation (Appendix 2) and the price tallying form providing 4

15 information with regard to the format of the NFB items. As variations in the availability of the NFB items were expected, a list of acceptable substitutes was established in consultation with the CBHSSSJB nutritionists. Training A one-day training session was provided to the three CBHSSSJB nutritionists assigned to survey the stores for price and availability of NFB items. Training was provided via a conference call on September 13, The conference call was also an opportunity to discuss additional substitutes for the NFB items that might not be available. Following this discussion, the MDD established a specific Price Tallying Form (Appendix 3, in French) as well as a list of modifications (Appendix 4: Modifications pour le relevé de prix Baie-James-Nord-du-Québec). Data Collection Price Tallying Price tallying was conducted on the last week of September 2011, in the 25 stores from which a written confirmation of participation (Appendix 1) had been received: 16 in Eeyou Istchee, 5 in Jamésie and 4 in Abitibi. Data Entry Electronic files for data entry, including particular data (e.g. item of a different size, missing information, etc.) were developed in consultation with the statistician and verified for accuracy. Results Analysis Detailed description on how the data was handled for analysis is provided under "Methodology. Report writing The MDD team was responsible for writing this report, in collaboration with the CBHSSJB nutritionists. Dissemenation of results and follow-up The CBHSSJB is responsible for the dissemination of the results and follow-up. 5

16 ACCESS TO A NUTRITIOUS FOOD BASKET IN EEYOU ISTCHEE METHODOLOGY The project on ACCESS TO A NUTRITIOUS FOOD BASKET IN EEYOU ISTCHEE is a descriptive portrait of the availability and cost of NFB items in stores in the Eeyou Istchee region (James Bay Cree territory), Jamésie as well as certain urban centers of Abitibi, where Eeyouch purchase food. There are nine (9) Eeyou Istchee communities, five (5) of which are referred to as coastal communities as they are located along the James Bay and Hudson Bay coasts: Chisasibi, Wemindji, Waskaganish, Eastmain and Whapmagoostui (Kuujjuaraapik). The remaining four (4) communities, Waswanipi, Nemaska, Oujé-Bougoumou and Mistissini, are located inland. Price tallying was conducted in 16 of the total 18 stores in these communities. There are five urban centres in Jamésie and price tallying was conducted in five (5) out of the six (6) stores of that region. In addition, price tallying was conducted in four (4) stores located in two (2) Abitibi urban centres where Eeyouch purchase food. DATA TREATMENT A verification of the tallied prices was conducted by the MDD. Any questionable or missing information (store size, NFB item weight, etc.) was verified with the CBHSSSJB nutritionists. When needed, items were coded according to the following specifications: food unavailable in store; missing data (e.g. weight of the product, expiration date); different size than specified; different product or different presentation than specified (frozen, for instance); questionable data (unusual weight, size, or price); product sold by unit (for which the price has to be adjusted to the specified weight). NFB Items Unavailable in Stores Unavailability of certain items was expected, and substitutes had been planned (Appendix 4). Nevertheless, unavailability of items still occurred and, because missing food items would artificially reduce the total cost of the food basket, a price had to be applied for these missing data. The following is the method used to estimate the cost of missing items: if the missing item was available in at least one other store within the same community, the median price of the item in the community was applied to the missing item; if the missing item was not available in the community but was available in other stores within the 16 stores of Eeyou Istchee, the median price of the item in these stores was applied to the missing item; 6

17 if the missing item was not available in the 16 stores in Eeyou Istchee, the median price of the item from the Jamésie and Abitibi stores was applied to the missing item. This methodology accounting for missing items can only be applied when a region is entirely represented. Therefore, it could not be applied to the Abitibi stores. Thus only three (3) of the Abitibi stores are considered in this report as one did not carry the NFB perishable items. Different Foods than those Specified In this project, suitable substitutes had been planned (Appendix 4) and were used when necessary. Because substitute items can impact overall cost of the NFB, each occurrence of substitution was noted (Appendix 5). Calculation of the NFB Cost As shown on Table 1, there are 71 items in the NFB. These items are classified into 22 food categories plus a MISCELLANEOUS one (items such as seasonings, beverages, etc.). In each store, the cost and size of each of the 71 food items were used to calculate its cost per kg. The weighted cost per kg of the category was the sum of the cost per kg of each item, multiplied by its respective percentage. For each group of age, sex and physiological condition, weekly food category allowances (Table 2) were established by the MDD in order to fulfill individual nutritional needs. The weekly NFB cost for one individual was obtained by multiplying the weighted unit cost of each of the 22 food categories by the weekly food category allowance and adding 5% for the inevitable food loss that occurs in domestic use 31. The cost per week of the NFB for a household was obtained by adding the weekly NFB cost for each person in the household. The MDD establishes the cost of the NFB for a reference family of four, which is comprised of a man and a woman both between 31 and 50 years old, a boy 14 to 18 years old, and a girl 9 to 13 years old. The weekly cost of the NFB for this family is designed as the Cost of the NFB in this report unless otherwise specified. Divided by 28 (7 days per week and 4 people per family), this cost sets the average cost of the NFB per person per day. For households of less than four people, the proportional cost of the NFB is increased in order to take into account the fact that the food formats used for price tallying are those that are suitable for a four-person household (i.e. bulk purchases). Thus, an increase of 5% for a three-person household, 10% for a two-person household, and 20% for a single person, is additionally applied to account for these food format differences 32. On the contrary, larger households (five or more people) would benefit from larger bulk formats but, unfortunately, low-income families do not have enough money to take advantage of such purchases. There are three types of milk in the NFB, but only one of these applies per group of age, sex and physiological condition. Therefore, there are 69 items per individual person in the NFB. 7

18 Table 1. CATEGORIES Foods Composition of the food categories in the NFB CATEGORIES - Foods MILK fresh (three types) 100% POTATO 100% MEAT OTHER VEGETABLES Beef, medium ground 19% Carrots 20% Beef, inside round 12% Onions 10% Beef, boneless stewing 7% Celery 5% Pork loin chops, with bone 14% Spinach 5% Boneless ham, quarter style 14% Broccoli 10% Chicken legs with back 34% Lettuce, iceberg 5% Turnip 5% LIVER pork 100% Green cabbage 5% Tomatoes 5% FISH Tomatoes, canned 10% Sole fillets, frozen 50% Tomato juice 3% Tuna, light, flaked, canned 15% Tomato paste 2% Salmon, pink, canned 35% Green peas 2% Corn, whole kernels 5% EGG, category A, large 100% Mixed vegetables, frozen 8% CHEESE BREAD Process, slices 40% Whole wheat 85% Cheddar, mild 30% Hot dog/hamburger buns 15% Mozzarella 30% BREAKFAST CEREALS PEANUT BUTTER 100% Shredded Wheat 20% Bran Flakes 20% LEGUMES Oatmeal, quick 60% Beans with pork, tomato sauce 20% Red kidney beans, canned 15% OTHER CEREAL PRODUCTS Chick peas, canned 15% Rice, long grain 30% Lentils, dry (12.5%) Macaroni / spaghetti 30% White beans, dry (12.5%) Flour, all purpose 30% 50% Red kidney beans, dry (12.5%) Flour, whole wheat 10% Split yellow peas, dry (12.5%) BUTTER/MARGARINE CITRUS FRUITS Butter 50% Oranges 50% Margarine 50% Orange juice, frozen 50% OTHER FATS OTHER FRUITS Mayonnaise (65% oil) 30% Apples 35% Vegetable oil (canola) 70% Bananas 35% Grapes 5% SUGAR Pears 10% Sugar, white 75% Cantaloupe 5% Sugar, brown 25% Fruit salad/cocktail in own juice 5% Raisins, bulk 5% SWEETS Strawberry jam 70% FLAX SEED 100% Honey 20% Molasses 10% INFANT FORMULA 100% MISCELLANEOUS* BABY CEREAL, iron enriched 100% Adult / Child * Seasonings, baking powder, tea, coffee, cocoa, etc. 8

19 9 Table 2. Food categories MILK Weekly food category allowances for each group of age (years), sex and physiological condition Unit* 0,5 to 1 Child Males Females Pregnancy Lactation 1 to 3 4 to 8 9 to to to to to to 8 9 to to to to to % fat Litre % fat Litre % fat Litre MEAT Kg FISH Kg LIVER Kg EGG unit 3 μ CHEESE g PEANUT BUTTER g LEGUMES α g CITRUS FRUIT Kg OTHER FRUIT Kg POTATO Kg VEGETABLES Kg BREAD sl. β BREAKFAST CEREALS g RICE/PASTA/FLOUR g BUTTER/MARGARINE g OTHER FATS g SUGAR g SWEETS g FLAXSEED g INFANT FORMULA δ g 609 BABY CEREAL g * under each group of age, sex and physiological condition, the quantity indicated corresponds to food as purchased rather than the edible portion μ yolk only α dry β slice ( 30 g) δ powder to to to to 50

20 INDEPENDENT VARIABLES The three independent variables considered in this project are store size, urbanization level and deprivation index. Store Size Stores were classified according to four sizes: very small ( 2,000 square feet); small (2 001 to 4,000 square feet); medium (4,001 to 10,000 square feet); large or very large (> 10,000 square feet). Urbanization Level The definitions used for the urbanization level are the Statistics Canada classification 33 adopted for the analysis of the deprivation index 34 as shown on Figure 1. The ZONE factor establishes the distinction between urban and rural areas. Urban areas correspond to metropolitan areas, cities, and municipalities with more than 10,000 inhabitants. Rural areas correspond to the sum of small communities that, by definition, count less than 10,000 people. Rural areas are further subdivided into three zones according to the respective influence of the metropolitan areas or cities have on employment. These zones of metropolitan influence (ZMI) are either strong, moderate or "weak or nil" 34. This classification is shown on Figure 1. Statistique Canada Classification Adopted Classification Metropolitan areas and cities 10,000 people URBAN- Z O N Small communities < 10,000 people RURAL-- E R U R A L Z O N E Strong ZMI 30% commuters Moderate ZMI 5 to 30% commuters Weak ZMI 0 to 5% commuters Nil ZMI 40 commuters Strong ZMII Moderate ZMII Weak/Nil ZMII Z M I Figure 1. Classification of urbanization levels: ZONES and ZMI (adapted from 34 ) Deprivation Index The deprivation index takes into account material and social dimensions of a population. Each residential area of Quebec has received a quotation for the measure of deprivation on each one of the components 35,36,37,38. Material deprivation is based on the following three indicators: the proportion of people 15 years of age or older with no certificate or high school diploma; the average income of people 15 years of age or older; the proportion of people 15 years of age or older who are on the job market. 10

21 Social deprivation is based on the following three indicators: the proportion of people 15 years of age or older living alone; the proportion of people 15 years or older whose matrimonial status is separated, divorced or widowed; the proportion of single-parent families. In this project, the deprivation index is used to link deprivation with the cost of the NFB. In order to do so, each store received a deprivation index corresponding to the average deprivation value of the residential areas situated within a one kilometre radius. Then, on the basis of the deprivation values attributed to each of them, the stores were grouped into quartiles on one or the other dimension. The middle quartiles were then combined to obtain a 3-level classification of weak, moderate and strong, containing 25%, 50% and 25% of the stores, respectively. ECONOMICAL DATA Among other factors, food security depends upon being able to afford sufficient food to be able to be active and healthy 39. In order to determine if the NFB is accessible to the people in Eeyou Istchee communities, the measure used in this report is the "Aftertax median income" in This measure is used for the following reasons: it is available per region and sub-region; it is available per family size; it corresponds to the amount of money available to households for acquiring goods and services, in other words for current consumption expenses. The NFB is generally measured for a family of four comprising a couple with two children. However, Eeyouch families are often larger. Therefore, in this report, the aftertax median income used is that of families with two children as well as that of families with three or more children. The average after-tax median income will be used for the following: average-income families comprising a couple; average-income single-parent families; low-income families comprising a couple; low-income single-parent families. ANALYSIS A total of twenty-one stores were surveyed in Eeyou Istchee and Jamésie, that is 16 (of 18 available) and 5 (of 6 available) respectively. Because in these two regions the population of stores was finite, finite population corrections (fpc) have been applied to standard deviations of descriptive statistics. This correction was not applied to statistical tests as the version of SPSS used (11.0) was not able to do so. Henceforth, results from statistical tests are accurate, although conservative. Frequency distributions are provided for Eeyou Istchee and Jamésie for the following categorical variables: store size, urbanization level (zone and ZIM), and deprivation index (material and social). Descriptive statistics are provided for: the weekly cost of the NFB for the reference family of four by region (Eeyou Istchee and Jamésie), subregion (coastal and inland of Eeyou Istchee), and community; average cost per person per day; and average weekly cost by group of age, sex and physiological 11

22 condition. The latter allows for easy calculation of the weekly cost of breastfeeding and comparison of this to the weekly cost of formula feeding. The cost of the NFB (which is a per week value) was multiplied by 52 to determine the annual cost, and subsequently divided by the median annual after-tax income of a family to illustrate the cost of the NFB in the Eeyouch economical context. This was calculated for the MDD reference family with two children as well for a family with four children, which is more representative of Eeyouch families. In each case, this was also done for a single parent, female-led household. Each of these calculations were conducted for families with an average income and those with a low-income. Descriptive statistics are also provided for the availability of food items for Eeyou Istchee (overall, by inland and coastal, and by community) and Jamésie. Additionally, a variable denoted truly missing in community has been provided to illustrate the actual availability of food items within a community; only if a food item is missing in all stores surveyed in a community is it considered truly missing. The effect of store size, urbanization level, and deprivation index on the cost of the NFB and on the availability of food items was investigated using ANOVA and regression analysis, as appropriate. In cases where the distribution of the data was not normal, the Welch statistic was used for categorical variables. For tests that were significant, post hoc analysis using the Tukey and Games-Howell statistics, as appropriate, were performed to determine where differences lie. The effect of deprivation index was investigated on all 21 stores together to maximize sample size in each quartile. T-tests were used to determine differences in cost of NFB and food availability between the coastal vs. inland region of Eeyou Istchee, as well as Eeyou Istchee vs. Jamésie. Chi-square analysis determined if there was a detectible difference in store size, urbanization level, or deprivation level between these regions, which might account for any observed differences in food cost and availability. The three stores from the Abitibi region are only summarily described. They were included in the store survey because they are among those frequented by the Eeyouch. As they were not randomly chosen, it would be inappropriate to conduct statistical analysis on these stores or include them with others, given the violation of the randomness assumption inherent to statistical techniques. The threshold for statistical significance was set at p <

23 ACCESS TO A NUTRITIOUS FOOD BASKET IN EEYOU ISTCHEE RESULTS EEYOU ISTCHEE DESCRIPTIVE RESULTS Surveyed Stores Table 3 describes the 16 stores of Eeyou Istchee according to store size, urbanization level and deprivation index. Most of these stores (11) are small, four are of medium size and only one exceeds 10,000 sq.ft. As none of the communities' populations exceeds 10,000 people, these stores serve a rural population in which there is no strong ZMI, i.e. they are not close to an urban centre. Concerning the deprivation index, which is a relative measure based on the 21 stores combined, the population appears to differ according to relative material and social deprivation. Material deprivation, which is linked to income, appears to be more present than social deprivation: only 2 out of 16 communities are of low material deprivation while 7 out of 16 are of low social deprivation. Table 3. Description of the sites of the 16 Eeyou Istchee stores in which price tallying was conducted according to store size, urbanization level and deprivation index Store size (n) Very small ( 2,000 sq. ft) 5 Small (2,001 to 4,000 sq. ft) 6 Medium (4,001 to 10,000 sq. ft) 4 Large/Very large (> 10,001 sq. ft) 1 Urbanization level Rural* (n) Moderate 13 Zones of metropolitan influence (ZMI) Weak or nil 3 * The population of all communities is less than 10,000 people. Deprivation index Level material (n) social (n) Weak 2 7 Moderate 8 5 Strong 6 4 According to the urbanization level, all Eeyou Istchee communities are classified as rural. Table 4 shows the distribution of the 16 Eeyou Istchee stores per community, according to store size as well as the dimensions of the deprivation index characterizing each community. 13

24 Table 4. Coastal Distribution of the 16 Eeyou Istchee stores according to store size per community and the deprivation index of the community Store size* (n) Deprivation index characterizing the community Very small Small Medium Large Material dimension** Social dimension*** Chisasibi 2 1 Moderate Weak Whapmagoostui 2 Strong Strong Wemindji 1 1 Strong Moderate Waskaganish 1 1 Strong Weak Eastmain 1 Moderate Moderate Waswanipi 1 1 Weak Strong Nemaska 1 Moderate Moderate Oujé-Bougoumou** 1 Moderate Moderate Mistissini 1 1 Moderate Weak * Very small ( 2,000 sq. ft) Small (2,001 to 4,000 sq. ft) Medium (4,001 to 10,000 sq. ft) Large/Very large (> 10,001 sq. ft) ** Variables linked to income level *** Variables linked to socialization (living alone / separated, divorced, widowed / single-parent families) Inland Availability of the NFB Items Although a list of acceptable substitutes had been established, there were NFB items commonly unavailable, both within individual stores as well as within entire communities. Among the 16 stores surveyed in Eeyou Istchee, there were four convenience stores. In three communities (Chisasibi, Waswanipi and Mistissini), the presence of a convenience store did not influence the number of unavailable NFB items: in Oujé- Bougoumou however the convenience store was the only store on site. This explains that more than half of the NFB items were missing in the community (Table 5): Thus, Eeyouch in Oujé- Bougoumou must purchase food from outside their community. In the other eight communities, the number of NFB items truly missing varies from 2 in Mistissini to 14 in Eastmain (Table 5). Table 5. NFB items truly missing per Eeyou Istchee individual community NFB items Communities Stores (n) missing (n) Chisasibi 3 4 Coastal Inland Whapmagoostui 2 5 Wemindji 2 6 Waskaganish 2 7 Eastmain 1 14 Waswanipi 2 13 Nemaska 1 7 Oujé-Bougoumou 1* 41 Mistissini 2 2 * Only a convenience store in the community In the 16 stores, out of 1136 NFB items (16x71), 271 or 23.8% were missing. In the 10 coastal stores, out of 710 NFB items, 119 or 16.8% were. In the 6 inland stores, 152 out 426 (6x71) or 35.7% were missing. Without accounting for Oujé-Bougoumou, the percentage decreases to 31.2%. In average, 17 items per store were unavailable representing 24% of the NFB items. Oujé-Bougoumou, with only a convenience store and 41 NFB items missing, is not taken into account on Table 6. This table shows the number of communities in which 19 NFB items were totally unavailable. Foods of similar nutritive value are part of the NFB multiple-item categories. In 14

25 the LEGUMES category, for instance, one item was available in all communities. Thus, nutritious needs could be met but variety was limited. Table 6. Number of Eeyou Istchee communities in which NFB items were totally unavailable* Unavailable in (n) of communities NFB category Item 5 Coastal 3 Inland* All 8 MILK 1% fat MEAT Beef, inside round 2 2 Beef, boneless stewing LIVER FISH White fillets 2 2 CHEESE Cheddar 1 1 Canned red kidney beans 2 2 Canned chick peas LEGUMES Dry lentils Dry kidney beans Dry split yellow peas 1 1 CITRUS FRUITS Orange juice 1 1 OTHER FRUITS Fresh pears or peaches 1 1 POTATO 1 1 Turnip or rutabaga OTHER VEGETABLES Broccoli 1 1 Fresh tomatoes 1 1 Frozen mixed vegetables 1 1 FLAX SEED * Oujé-Bougoumou, with only a convenience store and 41 unavailable NFB items, is excluded from the table. One-item category Appendix 5 presents a detailed description of the availability of the NFB items per store and per community. Table 7. Average cost of the NFB categories in Eeyou Istchee Food category Unit Coastal 10 stores Inland 6 stores Total 16 stores 1% fat 4 L $12.02 $7.91 $10.65 MILK 2% fat 4 L $10.89 $8.16 $ % fat 4 L $10.65 $8.06 $9.61 MEAT Kg $12.26 $10.66 $11.66 LIVER Kg $10.24 $9.27 $9.88 FISH Kg $19.14 $14.65 $17.45 EGG Unit $0.30 $0.26 $0.28 CHEESE Kg $22.53 $19.54 $21.41 PEANUT BUTTER Kg $9.68 $8.83 $9.36 LEGUMES * Kg $8.77 $7.10 $8.14 CITRUS FRUITS Kg $3.75 $2.53 $3.29 OTHER FRUITS Kg $4.91 $3.67 $4.44 POTATO Kg $2.06 $1.23 $1.75 OTHER VEGETABLES Kg $5.19 $3.89 $4.70 BREAD Kg $5.10 $5.40 $5.21 BREAKFAST CEREALS Kg $9.91 $7.31 $8.94 OTHER CEREAL PRODUCTS Kg $4.68 $3.78 $4.34 BUTTER/MARGARINE Kg $12.75 $10.84 $12.03 OTHER FATS Kg $7.91 $7.76 $7.85 SUGAR Kg $3.01 $3.00 $3.00 SWEETS Kg $9.74 $8.18 $9.15 FLAX SEED ** Kg $4.78 $4.78 $4.78 INFANT FORMULA Kg $42.84 $60.42 $49.43 BABY CEREAL Kg $28.18 $24.65 $26.86 MISCELLANEOUS Adult *** $3.21 $2.42 $2.91 Child *** $1.54 $1.24 $1.43 * The price in Jamésie was used. This item represents ⅛ of the category and 0.28% of the cost of the NFB. ** The price in Jamésie was used. This category represents 0.23% of the cost of the NFB. *** Weekly allowance 15

26 Cost of the NFB Categories Table 7 presents the cost of the 22 food categories in the NFB as well as the cost of the MISCELLANEOUS items for adults and children. The cost of the various food categories is higher in the stores of the coastal communities than in the ones located inland, except for the BREAD and INFANT FORMULA categories. Expiration Date The expiration date was verified for all the items included in the following NFB categories: MILK, CHEESE, EGG and BREAD. No expired perishable food items were noted for these categories in any of the Eeyou Istchee stores. Cost of the NFB per Group of Age, Sex and Physiological Condition Table 8 presents this cost in the Eeyou Istchee communities (coastal, inland and all respectively). The cost of the NFB for any household can thus be established. For instance, for the MDD reference family of four, the weekly cost of the NFB in Eeyou Istchee is: Man 31 to 50: $79.56 Woman 31 to 50: $71.23 Boy 14 to 18: $89.97 Girl 9 to 13: $71.71 for a total of $ as the Cost of the NFB. For a larger family with four children (MDD reference family + a boy 4 to 8 and a child 1 to 3), which is more representative of Eeyouch families, the cost of the NFB amounts to $ Table 8. Weekly cost of the NFB per group of age, sex and physiological condition in Eeyou Istchee Coastal communities 10 stores Inland communities 6 stores All communities 16 stores Group of age, sex and physiological condition Mean weekly NFB cost Standard deviation Mean weekly NFB cost Standard deviation Mean weekly NFB cost Standard deviation Child 6 months to 1 $42.48 $1.69 $50.33 $4.24 $45.42 $2.89 Child 1 to 3 $49.67 $1.54 $39.37 $0.85 $45.81 $1.36 Boy 4 to 8 $65.28 $1.97 $51.55 $1.66 $60.13 $1.81 Boy 9 to 13 $83.19 $2.50 $65.96 $2.18 $76.72 $2.28 Boy 14 to 18 * $97.22 $2.76 $77.89 $2.72 $89.97 $2.56 Man 19 to 30 $91.04 $2.54 $72.41 $2.48 $84.05 $2.41 Man 31 to 50 * $86.18 $2.37 $68.54 $2.45 $79.56 $2.27 Man 51 to 70 $85.31 $2.18 $67.79 $2.95 $78.74 $2.23 Man > 70 $81.98 $2.13 $65.06 $2.81 $75.63 $2.15 Girl 4 to 8 $62.25 $1.92 $48.99 $1.53 $57.28 $1.75 Girl 9 to 13 * $77.91 $2.41 $61.37 $1.99 $71.71 $2.19 Girl 14 to 18 $81.02 $2.50 $63.73 $2.12 $74.53 $2.28 Woman 19 to 30 $79.28 $2.25 $62.41 $2.18 $72.96 $2.16 Woman 31 to 50 * $77.41 $2.21 $60.92 $2.14 $71.23 $2.11 Woman 51 to 70 $76.90 $2.03 $60.75 $2.66 $70.84 $2.06 Woman > 70 $73.81 $1.99 $58.08 $2.54 $67.91 $2.00 Pregnant 18 $91.13 $2.63 $72.35 $2.15 $84.09 $2.44 Pregnant 19 to 30 $88.45 $2.61 $69.96 $2.08 $81.51 $2.40 Pregnant 31 to 50 $87.17 $2.59 $68.84 $2.01 $80.30 $2.38 Breastfeeding 18 $88.92 $2.61 $70.36 $2.09 $81.96 $2.41 Breastfeeding 19 to 30 $88.45 $2.61 $69.96 $2.08 $81.51 $2.40 Breastfeeding 31 to 50 $87.46 $2.59 $69.13 $2.03 $80.59 $2.39 MDD reference family $ $9.73 $ $9.27 $ $9.12 Four-children family α $ $ $ * member of the MDD reference family α This family (MDD reference family + a boy 4 to 8 and a child 1 to 3) is more representative of the families in Eeyou Istchee. 16